Efficacy of Statistical Outlier Analysis for Monitoring Quality of Care

Researchers have proposed that hospitals with excessive statistically unexplained mortality rates are more likely to have quality-of-care problems. The U.S. Health Care Financing Administration currently uses this statistical “outlier” approach to screen for poor quality in hospitals. Little is known, however, about the validity of this technique, since direct measures of quality are difficult to obtain. We use Monte Carlo methods to evaluate the performance of the outlier technique as parameters of the true mortality process are varied. Results indicate that the screening ability of the technique may be very sensitive to how widespread quality-related mortality is among hospitals but insensitive to other factors generally thought to be important.     

Childless Elders in Assisted Living: Findings from the Maryland Assisted Living Study

We compared data drawn from a random sample of 399 current assisted living residents and a subsample of 222 newly admitted residents for two groups: childless residents and residents with children. The percentage of childless residents (26%) in our study was slightly higher than U.S. population estimates of childless individuals aged 65 years and older (20%). In the overall sample, the two groups differed significantly by age, race, and women's years of education. The childless group was slightly younger, had a higher percentage of African American residents, and had more years of education than the group with children. In the subsample, we looked at demographic, functional, financial, and social characteristics and found that childless residents reported fewer diagnoses of dementia and fewer visits from a relative but more reported paying less money per month for assisted living and having private insurance than residents with children. As childlessness among older adults continues to increase, it will become increasingly important to understand how child status affects the need for and experience of long-term care.     

A comparison of social work education across South Africa and Japan in relation to the Global Standards for Social Work Education and Training

Sakaguchi H, Sewpaul V. A comparison of social work education across South Africa and Japan in relation to the Global Standards for Social Work Education and Training Int J Soc Welfare 2011: 20: 192–202 © 2009 The Author(s), International Journal of Social Welfare © 2009 Blackwell Publishing Ltd and the International Journal of Social Welfare. This article draws on a one‐year study visit to the University of KwaZulu‐Natal, South Africa, interviews with field supervisors and students in Japan and reviews of the national frameworks of education in Japan and in South Africa. In doing so, the authors identify the similarities and differences in social work education across the two countries and they explore some of the historical and socio‐cultural factors that might account for the differences. There are some identifiable peculiarities in social work education in Japan, especially with the coalescing of care work and social work education. The lack of differentiation between care work and social work makes it difficult to narrow the scope of social work education and practice. National social work standards have been approved in South Africa and regulatory frameworks for social work education and practice have been long accepted, thus rendering ‘social work’ a protected title and a profession that is more entrenched compared with social work in Japan. The codes of ethics in Japan and South Africa are discussed with specific reference to their control functions in South Africa. The article concludes by discussing these comparisons in relation to the Global Standards for Social Work Education.     

Competition and The Operational Performance of Hospitals: The Role of Hospital Objectives

We examine the effect of a hospital's objective (i.e., non‐profit vs. for‐profit) in hospital markets for elective care. Using game‐theoretic analysis and queueing models to capture the operational performance of hospitals, we compare the equilibrium behavior of three market settings in terms of such criteria as waiting times and patient costs from waiting and hospital payments. In the first setting, a monopoly, patients are served exclusively by a single non‐profit hospital; in the second, a homogeneous duopoly, patients are served by two competing non‐profit hospitals. In our third setting, a heterogeneous duopoly, the market is served by one non‐profit hospital and one for‐profit hospital. A non‐profit hospital provides free care to patients, although they may have to wait; for‐profit hospitals charge a fee to provide care with minimal waiting. A comparison between the monopolistic and each of the duopolistic settings reveals that the introduction of competition can hamper a hospital's ability to attain economies of scale and can also increase waiting times. Moreover, the presence of a for‐profit sector may be desirable only when the hospital market is sufficiently competitive. A comparison across the duopolistic settings indicates that the choice between homogeneous and heterogeneous competition depends on the patients' willingness to wait before receiving care and the reimbursement level of the non‐profit sector. When the public funder is not financially constrained, the presence of a for‐profit sector may allow the funder to lower both the financial costs of providing coverage and the total costs to patients. Finally, our analysis suggests that the public funder should exercise caution when using policy tools that support the for‐profit sector—for example, patient subsidies—because such tools may increase patient costs in the long run; it might be preferable to raise the non‐profit sector's level of reimbursement.     

《了不起的盖茨比》中威尔逊形象的生态解读

自2007年起,从生态批评的角度对《了不起的盖茨比》进行分析,逐渐成为学者研究的一个热门方向,然而绝大多数学者将目光集中在主要人物上,忽略了另一位极具代表性的小人物——威尔逊。威尔逊这一人物形象具有诸多意义,仅从生态角度来说,他便折射出了“爵士时代”下人与自然、人与社会以及人与自身的关系。通过利用生态批评这一理论工具,从自然生态、社会生态和精神生态这三个角度出发,对威尔逊的人物形象进行分析探讨,以期能够透过对于威尔逊的解读,得到对“爵士时代”中的人与自然、社会以及自身关系的更全面和深刻的认识。     

How Employed Mothers in Australia Find Time for Both Market Work and Childcare

Time use studies find that employed mothers reduce their parental childcare time by much less than an hour for every hour they spend in market work. This paper uses data from the Australian Bureau of Statistics Time Use Survey 1997 (4,059 randomly selected households) to investigate how employed mothers manage to avoid a one-for-one trade-off between work and childcare. It compares the time allocation of employed fathers, employed mothers and non-employed mothers and finds that parents use non-parental childcare to reschedule as well as to replace their own childcare, that employed mothers reschedule activities from weekdays to weekends or to earlier or later in the day, and spend less time than other mothers in housework, childfree leisure and personal care.

老舍文化视野中的市民世界及其精神内涵

老舍以市民世界畸型的心灵为切入点,深入剖析国民性格的积习和痼疾,开掘其历史文化渊源,并以理性之光寻找中西文化的"熔点"以重铸国民的理想人格,显示了他对国家民族命运的忧思和对未来理想社会的构想。     

Introspection as intra-professionalism in social and health care

This article analyses two cases from health and social care, adopting a psycho-societal approach. The analysis highlights how professionalism evolves and develops through an introspection of the relational and scenic processes between professionals, as well as between the professional and the client or patient. As a phenomenon at the core of professional practice, it will be argued that introspection needs to recognize and encompass the intra- and inter-psychic responses and understandings of professionals and their clients and patients. The first case places supervision as a learning space, where framing and complex exchanges of loss and confirmation, and of denial and displacement take place between a group of social workers and their supervisor. In the second case, it becomes apparent how the research interview opens up an opportunity for processing the emotions and socially critical experiences involved in hospital work.     

如何追求文学的精神高度——毕淑敏小说创作论

毕淑敏是一个不断开辟新的人生体验和文学描写的有追求的作家。她的创作给文坛带来新的界面，也提出新的命题。这突出体现在四个方面：作家气质：“白衣天使”与“天才病友”的路径选择；面对疾病：隐喻与治疗的相互矛盾；审视心灵：揭示痛苦与展现隐私的暧昧立场；伦理难题：医学一社会学一文学的彼此纠缠。对毕淑敏创作的深度分析，也同时揭示出当代文学如何追求精神高度的困难所在。     

High‐frequency family contact: a road to nowhere for infants

Understanding the practices which support the best interests of infants when placed in out‐of‐home care in the first year of life is a significant challenge. A study based in Victoria, Australia, explored the practice by the Children's Court of ordering high‐frequency contact (4–7 days a week) with the infant's mother and father when they are placed in care in the first year of life. A literature review revealed little attention to the issue of frequency of family contact for infants. An audit of case files of all infants in care in mid‐2007 showed that at 1 year follow‐up, there was no difference in the reunification rate for children with a period of high‐frequency contact and those with less contact with their mothers and fathers. Focus groups revealed deep divisions of opinion about high‐frequency family contact which are played out in the adversarial Children's Court system in Victoria. The study highlights the complexity of understanding and supporting the attachment relationships at this critical period in the infant's life.